Christine Blue: Sleep Disorders

Front 1

-24 hour sleep-wake cycle
-regulated by suprachiasmatic nucleus of ant. hypothalamus (SCN)

Back 1

Circadian Rhythm

Front 2

-Less than 24 hr rhythm
-NREM / REM sleep cycle
-complex physiology

Back 2

Ultradian rhythm

Front 3

Drive for sleep

Back 3

Homeostatic regulation

Front 4

the amount of time it takes to fall asleep

Back 4

Sleep Latency

Front 5

The amount of time it takes to reach first REM period; 90 min.

Back 5

REM Latency

Front 6

Deep sleep
-Occurs in the first 1/3 of sleep

Back 6

Delta

Front 7

___________ sleep decreases toward morning while ___________ increases toward morning.

Back 7

Delta

REM

Front 8

Very vivid, colorful, detailed sleep

Back 8

Occurs during REM

Front 9

What types of EEG waves occur when a person is active?

Back 9

Beta

Front 10

EEG wave when the person is awake, relaxed, eyes closerd

Back 10

Alpha waves

Front 11

The presence of this wave on EEG signifies first signs of sleep

Back 11

Theta

Front 12

What stage of sleep includes "sleep spindles" and "K complex" on the EEG?

Back 12

Stage 2

Front 13

What type of waves are seen in stage 3 and 4 sleep? What is the difference between the stages?

Back 13

Delta waves (slow wave sleep)

3 has fewer Delta waves.

Front 14

<50% delta waves

>50% delta waves

Back 14

Stage 3

Stage 3

Front 15

-Similar to awake stage
-"Sawtooth pattern"
-beta, alpha, and theta waves

Back 15

REM Sleep

Front 16

Eye Movements (EOG) are lowest during these stages of sleep

Back 16

Stages 2-4

Front 17

- “Light sleep” – easily awakened
-Slow, irregular brain waves (3-7 cps)
-Loss of alpha activity, theta waves present
-Lasts 5-15 minutes (5% total sleep time)
- Muscle activity slows, occasional twitching
- Slowed eye movements
- Pulse, respirations, and BP decrease

Back 17

Stage 1 Sleep

Front 18

-Still easy to awaken – may require shaking
-SLEEP SPINDLES: 25 sec bursts of 12-14 cps waves
-K COMPLEXES: 2 sec rise & fall
-LARGEST percentage of total sleep time (45-55%)
-Slight decrease in body temperature

Back 18

Stage 2 Sleep

Front 19

-“Deep sleep” begins - unresponsive to external stimuli
-Brain begins to generate slow delta waves (1-3 Hz)
-DELTA WAVES= 20 – 50% of EEG pattern
-Makes up 4 - 6 % total sleep time
-Eye movements absent
-SLEEPWALKING may occur

Back 19

Stage 3 Sleep

Front 20

-“Very deep sleep” – unresponsive
-Brain generates > 50% delta waves
- 12 -15% of total sleep time
-Limited muscle activity
- Eye movements absent
- Breathing is slow and rhythmic
-Sleep TERRORS may occur

Back 20

Stage 4 Sleep

Front 21

-“Active” or “paradoxical” sleep
-Associated with DREAMING (REM periods last 10 – 40 mins.)
-Makes up 20 – 25% of total sleep time
-ABSENCE of skeletal muscle movement (EMG = silent)
-Rapid eye movements occur
-Pulse, respiration, BP INCREASED but less regular
-NIGHTMARES and REM Sleep Behavior Disorder may occur

Back 21

REM Sleep

Front 22

Brain is metabolically active at these stages

Back 22

awake and REM sleep

Front 23

Normal time it takes to fall asleep

Back 23

15min.

Front 24

Sleep changes with age?

Back 24

-Decreased total Delta = feeling groggy, gets up earlier.

-Decreased total REM

Front 25

-Short REM latency

Back 25

Depression. (Instead of 90 minutes, REM starts @ 30.)

REM starts sooner and lasts longer.

Front 26

-Decreased total Delta sleep
-REM DECREASES toward morning (vs increasing in nml.)

Back 26

Depression

Front 27

Problem with the quality, amount of sleep.

Back 27

Dyssomnias

Front 28

Primary insomnia
Narcolepsy
Primary hypersomnia
Breathing related sleep disorder
Circadian rhythm sleep disorder

Back 28

Ex of Dyssomnias

Front 29

Difficulty initiating or maintaining sleep or non-restorative sleep

Lasts at least 1 month

Leads to daytime sleepiness

Back 29

Primary Insomnia

Front 30

Associated with significant distress or impairment in social or occupational function

Not related to another sleep disorder, medical or psychiatric disorder, or effects of a substance

Back 30

Primary Insomnia

Front 31

Non-pharm treatments for Primary Insomnias

Back 31

-Educate about good sleep hygiene
-Stimulus control therapy
-Sleep restriction therapy
-Relaxation therapy
-Psychotherapy (e.g., Cognitive Behavioral Therapy)

Front 32

short term use, controlled substances (schedule IV). Supress Stage 3-4 sleep.

Back 32

Sedative-hyponotics:
1. Benzos
2. Zaleplon
3. Zolpidem
4. Eszopliclone

Front 33

melatonin receptor agonist, non-controlled, long term use

Back 33

RozeremTM (ramelteon)

Front 34

may be used longer term for primary insomnias

Back 34

Sedating antidepressants (e.g., trazodone, amitriptyline, mirtazapine)

Front 35

(older medication) rarely used now (ED50 = LD50)

Back 35

Chloral hydrate

Front 36

-Irresistible “attacks” of sleep in inappropriate situations
-Cataplexy
-Poor or disturbed nocturnal sleep
-Hypnagogic or hypnopompic hallucinations
-Sleep paralysis
-Lifelong disorder
-Disturbance of REM sleep regulation

Back 36

Narcolepsy

Front 37

-Use Multple Sleep Latency Test to dx
-Falls asleep w/in 5 mintes

Back 37

Narcolepsy

Front 38

Treatment for Narcolepsy?

Back 38

1. Stimulants (methylphenidate, modafinil, sometimes amphetamines)
2. TCA's/SSRI's for cataplexy
3. Scheduled naps

Front 39

1. Excessive sleepiness either by prolonged sleep episodes or daytime sleep episodes.

Back 39

Primary Hypersomnia

Front 40

Will naps relieve primary hypersomnia?

Back 40

NO. This is 1 month in duration and causes significant distress. Primary hypersomina is not due to another sleep, med, psychiatirc or substance abuse disorder.

Front 41

RX for primary hypersomnia?

Back 41

-Response to treatment is usually poor
-Stimulants may help with sleepiness (see treatment for narcolepsy)
-Non-sedating antidepressants are sometimes helpful (e.g., fluoxetine, protriptyline)
-Sleep hygiene measures provide limited

Front 42

-Cessation of breathing for periods during sleep
-May be central or obstructive
-More common in middle-aged men and in obesity
-Nearly all patients snore
-Associated with medical consequences

Back 42

Breathing-Related Sleep DisorderSleep Apnea

Front 43

One of dz you must rule out for primary hypersomnia

Back 43

Sleep apnea

Front 44

Treatment of Sleep Apnea?

Back 44

1. CPAP or BiPAP = Treatment of choice
2. Weight loss
3. Avoidance of sedatives and alcohol
4. Antidepressants
5. Surgical:
UPPP (uvulopalatopharyngoplasty)
Tracheostomy

Front 45

What Class of Sleep Disorder?
1. Delayed Sleep Phase Syndrome (“night owl”)
2. Advanced Sleep Phase Syndrome (“morning lark”)
3. Time Zone Change Syndrome (“jet lag”)
4. Shift Work Sleep Disorder

Back 45

Circadian Rhythm Sleep Disorder

Front 46

RX for Delayed Sleep Phase Syndrome (“owl”)

Back 46

-Light therapy: Exposure to bright light in the morning
-Chronotherapy: Delay sleep by 2 or 3 hours each night

Front 47

Rx for Advanced Sleep Phase Syndrome (“lark”)

Back 47

1. Light therapy: Exposure to bright light in the evening (decreases melatonin)
2. Chronotherapy: Delay sleep to desired time

Front 48

RX for Time Zone Change Syndrome (“jet lag”)

Back 48

--Alter mealtimes and sleep time in appropriate direction before travel
--Melatonin has been used by some, but studies show little effectiveness

Front 49

RX for Shift work sleep disorder

Back 49

--Light therapy: Exposure to bright light during “daytime”
--Observe consistent “bedtime”

Front 50

Characterized by abnormalities in the physiology or in behavior associated with sleep

Back 50

Parasomnias

Front 51

-Repeated awakenings with recall of frightening dreams
-Usually occur in latter half of night during REM sleep

Back 51

Nightmare Disorder

Front 52

-Fully alert upon awakening
-The dreams or the sleep disturbance causes significant impairment
-Mostly seen in children but can be seen in adults

Back 52

Nightmare Disorder

Front 53

RX of Nightmare disorder

Back 53

1. Usually requires no treatment
2. Medications that suppress REM sleep (e.g., antidepressants, benzodiazepines)
3. Psychotherapy to address psychological trauma or anxiety provoking situational factors

Front 54

-Recurrent sudden arousals from DELTA sleep
-Associated with screaming, frantic motor activity, and autonomic arousal
-May not fully awaken after episode

Back 54

Sleep Terror Disorder

Front 55

-No detailed dream is recalled
-May co-occur with sleepwalking
-Causes clinically significant distress / impairment

Back 55

Sleep Terror Disorder

Front 56

-Repeated episodes of arising from sleep and WALKING about
-Occurs during delta sleep during first 3rd of the night

Back 56

Sleepwalking Disorder(Somnambulism)

Front 57

-Unresponsive during episode
-Amnesia for the episode on awakening
-Causes clinically significant distress / impairment

Back 57

Sleepwalking Disorder(Somnambulism)